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Individual

KENNETH S KOENEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
516 DELAWARE ST SE, PWB FIRST FLOOR, CLINIC 1E, MINNEAPOLIS, MN 55455-0356
(612) 626-6666
Mailing address
420 DELAWARE ST SE MMC 394, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 626-6666

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
46470
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1040762
PREFERRED ONE
MN
01
131340
UCARE
MN
01
19-00018
MEDICA-PRIMARY
MN
01
19-00591
MEDICA-CHOICE
MN
01
2162398
ARAZ
01
455R5KO
BCBS
MN
01
692293
FAIRVIEW
MN
01
B715
CHAMPUS
01
HP40917
HEALTH PARTNERS
MN
Enumeration date
10/13/2006
Last updated
07/08/2007
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